Safety of Coupled Arterial Anastomosis in Autologous Breast Reconstruction

Abstract

Background This study compares the outcomes of coupled versus hand-sewn arterial anastomosis in microvascular breast reconstruction. Methods Retrospective chart review of breast reconstruction free flaps performed between 2013 and 2018 was conducted. Primary end points included flap loss, intraoperative arterial anastomosis revision, and operating room takeback. The decision to couple the arterial anastomosis was based on patient's age, surgeon's preference, history of radiation, and vessel quality. All anastomoses were performed under ×3.5 loupe magnification to internal mammary or thoracodorsal vessels. Results Authors reviewed 104 free flaps; two were lost in hand-sewn group; no flaps were lost in coupled group. There was no significant difference in anastomotic revision rate between coupled and hand-sewn arterial anastomosis (p = 0.186) or return to operating room (OR) between coupled and hand-sewn flaps (p = 1.000). Reasons for takeback included venous congestion and hematoma. Conclusion This study reflects that coupled arterial anastomosis in breast reconstruction may be safely performed without increased risk in anastomotic revision, takeback, or flap loss. Decision to couple should be based on surgeon skill, patient age and history, and assessment of flap and recipient site vasculature.

Erhöhung der Sicherheit in der mikrochirurgischen Brustrekonstruktion – Technik und Technologie

“…Im Gegensatz hierzu ist die Datenlage für die Koppler-gestützte arterielle Anastomose problematischer. Obgleich McLaughlin et al in einer vergleichenden Analyse von "gekoppelten" und "handgenähten" arteriellen Anastomosen bei 104 mikrochirurgischen Brustrekonstruktion keine signifikanten Unterschiede bei der Revisionsrate der Anastomosen (p = 0,186) oder Reoperation (p = 1,000) feststellen konnten [8], zeigten Perfitanis et al in einer systematischen Übersichtsarbeit von insgesamt 351 freien Lappenplastiken eine erhöhte Komplikationsrate der arteriellen Koppleranastomose im Vergleich zu der Handnaht-Technik [9].…”